Treatments for stage I bladder cancer

The following are treatment options for stage I bladder cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery

Surgery is the main treatment for stage I bladder cancer. If most or all of the bladder isn’t removed, surgery is followed by intravesical immunotherapy or chemotherapy. The following types of surgery can be used:

Transurethral resection(TUR) uses a special instrument passed through a cystoscope to remove the tumour along with a margin of tissue around it. The surgeon then burns the area from where the tumour was removed with a high-energy electric current (called fulguration) or a laser. This procedure seals off blood vessels and destroys any remaining cancer.

Partial, or segmental, cystectomy removes the tumour and part of the bladder around the tumour. It is used when the tumour is in a part of the bladder that can be safely removed.

Radical cystectomy removes all of the bladder along with surrounding fatty tissue and nearby lymph nodes. Some reproductive organs may also be removed. In men, the prostate may be removed. In women, the ovaries, the uterus or part of the vagina may be removed. A radical cystectomy may be done if the tumour continues to grow after one or more treatments with a TUR, a partial cystectomy, intravesical immunotherapy or chemotherapy. After removing the bladder, the surgeon creates a new passage for the urine (called a urinary diversion).

Immunotherapy

Immunotherapy is a type of biological therapy that uses the immune system to help destroy cancer cells. Biological therapy uses natural or artificial substances that act like (mimic) or block natural cell responses to kill, control or change the behaviour of cancer cells.

Immunotherapy is usually given after a TUR for stage I bladder cancer. Bacillus Calmette-Guérin (BCG) is the most common immunotherapy used to treat bladder cancer. A catheter, or tube, is passed through the urethra and into the bladder so that BCG is given directly into the bladder (called intravesical immunotherapy).

Chemotherapy

Chemotherapy may be given for stage I bladder cancer. You may be offered chemotherapy instead of BCG after a TUR to treat low-grade, non-invasive tumours. Chemotherapy is used instead of BCG if you are not well enough to cope with the side effects of BCG. It may also be used to treat tumours that come back, or recur, and don’t respond to BCG.

Chemotherapy is usually given directly into the bladder through a urinary catheter, or tube (called intravesical chemotherapy).

The most common chemotherapy drugs used for stage I bladder cancer are:

mitomycin (Mutamycin)

doxorubicin (Adriamycin)

gemcitabine (Gemzar)

Radiation therapy

External beam radiation therapy is rarely used to treat stage I bladder cancer. But it can be used instead of a cystectomy in some cases.

Clinical trials

You may be asked if you want to join a clinical trial for bladder cancer. Find out more about clinical trials.